Nation's Health Plans Now Judged on Quality Standards for Treatment of Alcoholism

Nation's Health Plans Now Judged on Quality Standards for Treatment of Alcoholism

A tool that 90% of the nation's health plans already use to assess their performance in treating asthma, diabetes, and high blood pressure now includes new measures for how well plans do in treating patients who have been diagnosed with alcoholism and other drug disorders. According to a report released today by Ensuring Solutions to Alcohol Problems, holding plans accountable for timely and effective alcohol treatment should lead to improved service delivery and more informed health care contract negotiations.

The new primer, Using Performance Measurement to Improve the Quality of Addiction Treatment, focuses on the inclusion of leading addiction treatment indicators in a popular performance measurement tool called the Health Plan Employer Data and Information Set (HEDIS) as part of a broader explanation of how both the private and public sectors are using performance measurement to demand greater accountability from health care providers. 

"This information can help health plans improve the delivery of services during the critical front end of treatment," said Eric Goplerud, PhD, Executive Director of Ensuring Solutions. "It can enable private employers and government agencies--two groups with enormous purchasing power in the health care industry--to negotiate quality improvements in addiction treatment from health plans when their contracts to provide these services come up for renewal." 

The stakes are enormous. Although alcohol problems kill 100,000 Americans and cost the nation nearly $185 billion each year, treatment for alcoholism last year ranked dead last in a study that compared treatment quality for the 25 leading causes of death, injury hospitalization and reasons for visiting a doctor's office. In fact, according to the authors of the same study, published in the New England Journal of Medicine , fewer than 10% of Americans being treated for alcoholism receive care based on established clinical guidelines, clinical evidence, and/or expert consensus. 

With federal funding, the Washington Circle, a volunteer panel of experts, developed the new addiction treatment measures that are now included in HEDIS. The National Committee for Quality Assurance (NCQA), a non-profit accrediting organization with a mission to improve health care, developed and maintains the HEDIS tool. 

"Alcoholism and drug addiction are among our nation's most serious health issues," said NCQA President Margaret E. O'Kane. "At the same time, there is enormous opportunity to improve health care quality in these areas. Adding the alcohol and other drug measures to HEDIS will encourage health plans to focus on getting people the care and support they need to get well again." 

"NCQA's remarkable success in stimulating quality improvement in treatment for asthma, diabetes and high blood pressure--all diseases which, like alcoholism, require behavior change--is indicative of what public reporting of HEDIS measures can accomplish," added Goplerud. "The inclusion of these addiction treatment measures in HEDIS finally gives alcoholism a place on the nation's health care agenda that is commensurate with its devastating impact on individuals, families and communities." 

Ensuring Solutions based Using Performance Measurement to Improve the Quality of Addiction Treatment on a review of research literature and interviews with academic researchers and health care professionals. The primer was developed in conjunction with Constance Horgan, ScD, who directs the Center for Behavioral Health at Brandeis University's Schneider Institute for Health Policy. It is the sixth in a series developed by Ensuring Solutions to inform business leaders and policymakers about a drug problem that directly affects an estimated 14 million Americans as well as their families, workplaces and communities. 

Based at The George Washington University Medical Center in Washington, DC, Ensuring Solutions ( is funded by The Pew Charitable Trusts and seeks to increase access to treatment for individuals with alcohol problems.